HomeMy WebLinkAboutRequest to Advertise - Fire Station #4Date 10-31-16
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Department Public Works
Name
Kevin Fink
Division/Bureau
Engineering
BPW Date
11-08-16
Phone Extension
5903
I Required Prior to Submittal to Board
Legal ® Attorney Name: Michael Schmidt
Controller ® Controller review is required for all Contracts $5,000.00 or more and
greater than one year in length per the City Purchasing Policy
Purchasing
Check the Appropriate Item Type — Required for All Submissions
❑
Agreement
❑ Contract ❑ Proposal ❑ Addendum
❑
Professional Services
❑ Resolution
❑
Bid Opening
❑ Bid Award ® Req. to Advertise ® Title Sheet
❑
Quote Opening
❑ Quote Award
❑
Change Order No.
❑ C/O & PCA No. ❑ PCA
❑
Ease/Encroach.
❑ Traffic Control:
n
Other:
Company or Vendor Name
New Vendor
MBE/WBE Contractor
MBE/WBE Contractor Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
Amount of
Increase
Decrease
Information
❑ Yes ❑ No ❑ if Yes, Approved by
Purchasin
MBE WBE
❑ No ❑ Yes Name of Company
Fire Station #4
116-066
West TIF area
050-460.36-01
Request to Advertise, Notice to Bidders, and Title Sheet
❑ Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
Chanqe Orders
ieVROVED
Previous Amount $ n
Current Percent of Change: % 4 r New Amount $ ! `•� L:
Total Percent of Change: %
Dispersal After Approval
Copy Original
® ❑ Steve Cox
® ❑ Todd Skwarcan
® ❑ Kevin Fink